Genital prolapse: epidemiology, clinic and therapeutic at Saint Joseph Hospital of Kinshasa

The aim of the study was to describe the epidemiological, clinical and therapeutical profile of genital prolapse in the gynecology and obstetrics service of Saint Joseph Hospital of Kinshasa. This is a descriptive study carried out from medical files of patients who have suffered from genital prolapse in the gynecology and obstetrics service of Saint Joseph Hospital from January 1st, 2008 to December 31st, 2017. It is based on the no probabilistic sampling of suitability. We recorded 161 cases of genital prolapses upon 13957 patients. The genital prolapses frequency was 1.2% with an annual average of 16.1 cases (SD 10.1) per year. The symptomatology consisted of pelvic mass associated with urinary and digestives troubles (94.0%, n=140). The stage III of cysto-colpocele was the most frequent (56.0%, n=82). The vaginal hysterectomy associated to rectocele and cystocele cure was the most performed operation (52.0%, n=69). The recurrence rate was of 2.0% (3 out of 148 cases). The genital prolapse really exist in our milieu, its symptomatology is classical and its treatment is mostly surgical by vaginal access.

Automatic Cystocele Severity Grading in Ultrasound by Spatio-Temporal Regression

Cystocele is a common disease in woman. Accurate assessment of cystocele severity is very important for treatment options. The transperineal ultrasound (US) has recently emerged as an alternative tool for cystocele grading. The cystocele severity is usually evaluated with the manual measurement of the maximal descent of the bladder (MDB) relative to the symphysis pubis (SP) during Valsalva maneuver. However, this process is time-consuming and operator-dependent. In this study, we propose an automatic scheme for csystocele grading from transperineal US video. A two-layer spatio-temporal regression model is proposed to identify the middle axis and lower tip of the SP, and segment the bladder, which are essential tasks for the measurement of the MDB. Both appearance and context features are extracted in the spatio-temporal domain to help the anatomy detection. Experimental results on 85 transperineal US videos show that our method significantly outperforms the state-of-the-art regression method.

Etiopathogenic, therapeutic and histopathological aspects upon the anterior vaginal wall prolapse

The pelvine organ prolapse (POP) is a condition affecting million of women, with a major impact upon the social and professional life of the patients. According to various studies, it affects approximately 40% of the women aged over 50 years. About 10% of women with POP require a surgical procedure for POP or urinary incontinence. Our study comprised a number of 14 patients, aged between 55 and 70 years, hospitalized and treated in the Clinic of Urology within the Emergency County Hospital of Craiova, Romania, between 2011 and 2013, for second-degree cystocele. Of these, 11 (78.57%) patients had more than two natural deliveries, 10 suffered more than three abortions, and eight (57.14%) women suffered from obesity. The increase of abdominal pressure, induced by chronic coughing, constipation or hard physical work, was identified in more patients. Thus, six (42.8%) patients presented chronic bronchitis, four (28.57%) patients were smokers, eight (57.14%) patients presented chronic constipation, and 10 (71.42%) patients stated that they had performed hard physical work. The presence of effort urinary incontinence, associated to the cystocele, was found in eight (57.14%) cases. The surgical intervention consisted in the performance of a direct cystopexia with a synthetic tent, placed in a transobturatory way, in a "tension free" manner (Perigee System). The post-operatory evolution was a good one; the results after six months showed that 12 (85.71%) women were cured, two (14.29%) cases of cystocele relapsed, while in two patients there maintained the effort urinary incontinence. The histopathological examination of the anterior vaginal wall fragments, harvested during the surgical intervention, showed the presence of a chronic inflammatory infiltrate in the lamina propria of the uterine mucosa, which may cause the post-operatory relapses. We consider that the reduction of the inflammatory process through the administration of anti-inflammatory drugs could reduce the POP onset and progress.

Effectiveness of transvaginal colporrhaphy with porcine acellular collagen matrix in the treatment of moderate to severe cystoceles

PURPOSE

The aim of this study was to determine the effectiveness of transvaginal anterior colporrhaphy with the use of porcine acellular collagen matrix in the treatment of moderate to severe cystocele.

MATERIALS AND METHODS

This retrospective study included 95 patients who underwent anterior colporrhaphy with the use of porcine dermus from September 2003 through March 2008 at the Gynaecological Department of University General Hospital of Alexandroupolis in Greece. The inclusion criterion was a grade 2-4 cystocele by the Baden-Walker halfway system. Postoperatively patients were evaluated at one, six and 12 months. Objective cure was defined as no or grade 1 cystocele with an asymptomatic patient at 12 months postoperatively. Improved outcome was considered as an asymptomatic patient with a grade 2 cystocele and failure symptomatic patients or with grade 3 or 4 cystocele.

RESULTS

All of the patients had a 12-month postoperative follow-up or were noted as a failure prior to the 12-month assessment. The majority of the women were menopausal (88.4%) and overweight (mean BMI 26.1). The overall cure rate was 81.1%, the improvement of the cystocele was 10.5% while the failure rate was 8.4%. The complications we noted were vaginal erosion in 2.01% and graft extrusion in 1.05% of the patients.

CONCLUSION

Transvaginal anterior colporrhaphy using porcine dermal in the treatment of moderate to severe cystocele is simple, safe, easily learned and performed with a high success rate and low morbidity.

Patient-selected goals: the fourth dimension in assessment of pelvic floor disorders

The purpose of the study was to assess the relationship between self-expressed urogynecologic goals, symptoms, and treatment choice. Charts of women presenting for urogynecology consultation were reviewed. Demographics, diagnoses and responses to the pelvic floor distress inventory and medical, social, and epidemiologic aspects of aging questionnaires were recorded. Patients listed urogynecology goals before consultation. We categorized goals into five categories and then compared these categories by symptom type, severity, and treatment. Three hundred five women reported 635 goals (median 2, range 1-6). The number of goals listed per patient did not differ by age, race, comorbidities, or clinical diagnosis (p > 0.05). The most frequent goal category was symptoms (67%), followed by information seeking (12%), lifestyle (11%), emotional (4%), and "other" (6%). Women selecting non-surgical treatment were more likely to list information seeking as primary goal than those who chose surgery (p = 0.009). One third of participants expressed a primary non-symptom goal and were more likely to seek non-surgical therapy.

The Colpexin Sphere: a new conservative management option for pelvic organ prolapse

Pelvic organ prolapse is a frequently overlooked condition occurring commonly among women of all ages. A brief overview of pelvic organ prolapse and a discussion of the Colpexin Sphere is provided. The Colpexin Sphere is a new intravaginal device that facilitates the performance of pelvic floor muscle exercises thereby enhancing the benefit provided by already established conservative therapy.

Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free polypropylene mesh

We report a case series of 63 women with cystocele who underwent the same trans-vaginal procedure between October 1999 and October 2002. The polypropylene mesh (GyneMesh, Gynecare, Ethicon, France) was placed from the retropubic space to the inferior part of the bladder in a tension-free fashion. Patients were followed up for 24 to 60 months, with a mean follow-up of 37 months. Fifty-five patients returned for follow-up (87.3%). At follow-up, 49 women were anatomically cured (89.1%), five women had stage 2 anterior vaginal wall prolapse (9.1%), and one had a recurrent stage 3 (1.8%). Functional results and sexual function were also investigated. Fifty-three women had significant improvement in their quality of life (96.4%). There were a total of three cases of local pain around a mesh shrinkage (5.5%) and five vaginal erosions of the mesh (9.1%). Four out of 24 patients had dyspareunia (16.7%). In conclusion, the vaginal repair of anterior vaginal wall prolapse reinforced with a polypropylene mesh was efficient at 2 to 5 years follow-up. However, the first generation of polypropylene mesh we used was responsible for high rates of local complications and dyspareunia. Therefore, the polypropylene mesh has to be improved (lower weight) and the technique has to be documented by a randomized controlled trial before we could recommend its use in clinical practice.

Pessary Treatment of Pelvic Relaxation

OBJECTIVES

The aims of this study were to determine predictors of successful pessary fitting and continued pessary use in patients with pelvic relaxation.

DESIGN

Retrospective observational study.

SETTING AND SUBJECTS

The medical records of 130 consecutive patients evaluated for pessary treatment of pelvic relaxation by a single specially trained nurse practitioner (CRJ) at Kaiser Foundation Hospital, Harbor City, Calif, between May 1, 1997, and June 30, 2002, were retrospectively reviewed.

INSTRUMENTS

Voiding diaries, data collection sheet, and questionnaires.

METHODS

The medical records of the 130 patients were retrospectively reviewed, and data were recorded on data collection sheets. Patients using pessaries completed a questionnaire to assess treatment effectiveness.

RESULTS

Coexisting stress urinary incontinence and previous prolapse and cystocele/rectocele repairs were each found to be independent predictors of unsuccessful pessary fitting. Fifty percent of successfully fitted patients had discontinued pessary use by 24 months. Current pessary users were more likely to have undergone prior pelvic reconstructive surgery (37% vs 13%, P = .02), less likely to require a space-filling pessary (13% vs 37%, P = .03), and more likely to recommend pessary to their friends or family (87% vs 50%, P = .007) compared to patients who discontinued pessary use.

CONCLUSIONS

Prior pelvic reconstructive surgery is associated with an increased risk of unsuccessful pessary fitting; however, those patients who are successfully fitted tend to continue pessary use.